The clinical and anthropometric profile of undernourished children aged under 5 admitted to Nyangabgwe Referral Hospital in Botswana

BACKGROUND. Although Botswana is a middle-income country, undernutrition among children younger than 5 years of age is still seen in various parts of the country. There is little information on the clinical and anthropometric profile of undernourished children in this age group admitted to hospitals in Francistown, Botswana. PURPOSE. To determine the clinical profile and the severity of anthropometric failure of undernourished children aged under 5 admitted to Nyangabgwe Referral Hospital in Francistown. METHOD. Data were collected from 113 caregiver-child pairs using a researcher-administered questionnaire targeting caregivers together with the children’s hospital records. The children’s anthropometric measurements were taken. Data were analysed using the WHO Anthro 2006 software and Stata 10. Proportions were then calculated. RESULTS. The median age of the children was 14 months and 55% were boys. The majority of the caregivers were single, younger than 30 years and lived in rural villages. The most common symptoms on admission were oedema (50%) and coughing (35%). Ten per cent of the children were HIV-infected and the HIV status of half the children was unknown. The majority (87%) did not present with secondary diagnoses. Severe wasting (<-3 standard deviations (SD)) (73%) was found in all age groups. Stunting (<-2 SD) was prevalent in 68% of the boys, and 95% of the children were severely underweight (<-3 SD). CONCLUSION. Oedematous undernutrition was common and 73% of the children presented with severe wasting (<-3 SD). In order to prevent severe forms of undernutrition, avoid the necessity for complicated care and improve the chances of survival, health education to caregivers on various forms of undernutrition is crucial.The Directorate General for Development Cooperation (DGDC) through the Flemish Interuniversity Council (VLIR-OUS).http://www.sajch.org.za/index.php/SAJCHam201

School-based nutrition education : features and challenges for success

PURPOSE – The aim of this review is to critically assess published articles on school-based nutrition education (NE) intervention to identify factors hindering or contributing to the success of interventions. School-based NE possesses the capacity to influence learners’ nutrition behaviours. DESIGN/METHODOLOGY/APPROACH – An electronic search of articles was conducted in Medline, PubMed, the Cumulative Index to Nursing and Allied Health Literature databases, Google and snowballing. Included in the review were school-based studies with classroom NE with or without nutrition services and studies published between 2000 and 2013. School-based non-intervention studies and interventions that did not include a nutrition teaching component were excluded in the review. FINDINGS – Thirty-nine studies met the inclusion criteria. Features of successful NE interventions included the use of behavioural theories, especially the social cognitive theory and the involvement of trained teachers in the implementation of interventions. Capacity development for teachers, time constraints, school policies and implementation problems of multicomponent interventions were some of the identified challenges encountered in the studies reviewed. ORIGINALITY/VALUE – Trained teachers are invaluable assets in interventions to improve nutrition behaviours of learners. Challenges associated with teacher-oriented school-based NE intervention can be overcome by properly designed and implemented interventions based on behavioural theory.http://www.emeraldinsight.com/0034-6659.htmhb201

Dietary quality and patterns and non-communicable disease risk of an Indian community in KwaZulu-Natal, South Africa

BACKGROUND : Limited data exist on the South African Indian diet despite their high prevalence of non-communicable diseases. This study attempted to determine the dietary quality and patterns of an Indian population in KwaZulu-Natal with reference to the high prevalence of non-communicable disease METHODS : Two-hundred-and-fifty apparently healthy Indians, aged 35–55 years participated in a cross-sectional study where diet was assessed using a validated quantitative food frequency questionnaire. Mean intakes were compared to the World Health Organization goals. Dietary quality was determined by index construction and dietary patterns by factor analysis. RESULTS : The mean daily percentage of energy (%E) from n-3 fatty acids (0.24 %E), dietary fibre (18.4 g/day) and fruit and vegetable intakes (229.4 g/day) were below the World Health Organization goals. Total fat (36.1 %E), polyunsaturated fatty acids (11.8 %E), n-6 fatty acids (11 %E) and free sugars (12.5 %E) exceeded the goals. The means for the deficient index reflected a moderate diet quality whereas, the excess index reflected good diet quality. The Pearson partial correlation coefficients between the deficient index and risk markers were weak whilst, the excess index was inversely correlated with waist circumference for the whole sample. Two factors were identified, based on the percentage of fat that contributed to each food group: factor 1 (meat and fish versus legume and cereal pattern), which accounted for added fat through food preparation; and Factor 2 (nuts and seeds versus sugars and visible fat pattern), which accounted for obvious fat. The medians for waist circumference, blood glucose, cholesterol and triglyceride levels showed significant decreasing trends for factor 1 (p < 0.05). The medians for blood glucose and cholesterol showed significant decreasing trends for factor 2 (p < 0.01). CONCLUSION : A shortfall of fruit and vegetable, fibre and n-3 fatty acid intake in the diet is highlighted. When assessing the diet quality and patterns, guidance on the prudent use of added fats may lead to a healthier lifestyle reducing the prevalence of non-communicable diseases.Grants from the South African Medical Research Council, National Research Foundation; Thuthuka and North-West University.am201

Development, implementation, and process evaluation of a theory-based nutrition education programme for adults living with HIV in Abeokuta, Nigeria

INTRODUCTION : Healthy diets play a role in the management and care for adults living with HIV/AIDS (ALH). Appropriate nutrition education (NE) is necessary to equip ALH with relevant knowledge and skills for healthy eating. A needs assessment identified the need for a nutrition education programme (NEP) as part of the nutrition service for ALH in Abeokuta, Nigeria. The aim of this study was to design a theory-based NEP and to evaluate the implementation process among ALH attending selected federal and state hospitals in Abeokuta as out-patients. MATERIALS AND METHODS : An exploratory descriptive needs assessment in the qualitative and quantitative domains was conducted among a convenient sample of ALH (N = 243) at the selected hospitals. The quantitative needs assessment identified needs for improvement in the primary outcome [quality of life (QoL)] and the secondary outcomes [quality of dietary intake, nutrition knowledge, attitudes, and practice (KAP), and anthropometric status]. Participants’ perceptions of the NEP were obtained using an interviewer administered questionnaire among 70 ALH who attended the implementation of the NEP and process evaluation thereof at the intervention hospital. RESULTS : The qualitative results identified a lack of knowledge on planning varied meals with limited resources. The identified needs, existing guidelines and literature were integrated with appropriate constructs of the Social Cognitive Theory (SCT) and the Health Belief Model (HBM) into the NEP. The NE manual, participant’s work book, flipcharts, and the brochure were tailored to address the identified challenges. DISCUSSION : The process evaluation showed that the NEP was implemented as planned and that the participants’ perceptions were positive. The use of the NE manual, participant’s work book, flipcharts, and brochure demonstrated the practicality of incorporating behavioral theories in NE for ALH.The Department of Research and Innovation (DRI) of the University of Pretoria, Tertiary Education Trust Funds (TET Funds), and Red Cross International Lagos.https://www.frontiersin.org/journals/public-health#am2019Human Nutritio

A cross-sectional comparison of nutrition knowledge, attitudes and dietary practices between learners and teachers in primary schools in a resource limited community in Bronkhorstspruit, South Africa

Optimal nutrition knowledge is necessary for healthy dietary behaviours to occur. Nutrition knowledge, attitudes and dietary practices (KAP) scores for learners have been variously reported in literature, however with little or no information on how the nutrition KAP status of teachers impart on learners. The study aimed to assess the nutrition KAP status of learners and of teachers in order to ascertain the impact and transfer of nutrition information from teachers to learners. The results suggest that teachers’ high nutrition knowledge and attitudes status have not been effectively impacted on learners. It also suggests a need to improve or modify methods of nutrition information delivery by teachers in a way to improve learners’ dietary behaviours.This paper was initially delivered at the Faculty of Education and Department of Physiology at the University of Pretoria, Groenkloof Campus, South Africa on 16 October 2013.http://www.satnt.ac.zaam201

Measuring micronutrient intakes at different levels of sugar consumption in a population in transition : the Transition and Health during Urbanisation in South Africa (THUSA) study

OBJECTIVE: The objective was to investigate the absolute micronutrient intake and the possibility of micronutrient dilution of added sugar in the diets of an African population in nutritional transition. DESIGN: A cross-sectional, comparative, population-based design was used. Respondents who consumed sugar were divided into four quartiles of percentage of added sugar intake. SETTING: The setting was 37 randomly selected rural and urban areas of the North West province. SUBJECTS: The subjects were 1 742 adult volunteers (739 men and 1 003 women), aged between 15-65 years. After exclusion of low-energy reporters, the sample comprised 1 045 subjects (472 men and 573 women). OUTCOME MEASURES: The outcomes measures were the macronutrient and micronutrient intakes of subjects in different quartiles of added sugar intake and body mass index (BMI). RESULTS: The average intake of added sugar was 10.01% of total energy (67.12 g) in men and 11.2% total energy (67.10 g) in women. Respondents who consumed the most added sugar had significantly lower mean intakes of alcohol, but higher intakes of energy, macronutrients and most micronutrients. The diets of those in the highest sugar intake group contained significantly less thiamine, riboflavin, niacin, vitamin B12, pantothenic acid, biotin, magnesium, phosphorus and zinc per 4.18 MJ. At every level of added sugar consumption, the mean intakes of fibre (men only), folate, ascorbic acid and calcium (men and women) did not meet the dietary reference intakes [estimated average requirements (EAR)] and pantothenic acid and biotin (women only) did not meet the adequate intake. There were no significant differences in mean BMI across the quartiles of added sugar intakes in men, but the mean BMI of women who consumed the most added sugar was significantly higher than that of those who consumed less sugar. Respondents who consumed the most added sugar had significantly higher intakes of fruit (men only), bread and soft drinks, and lower intakes of maize meal and alcohol (men and women). CONCLUSION: Absolute intakes of most micronutrients were significantly higher in consumers with a high sugar intake [Quartile (Q) 4] compared with the lowest consumers of sugar (Q1). The lowest percentages of participants whose micronutrient intakes fell below the EAR were in Q4 and Q3. However, expression of micronutrient intake per 4.18 kJ (micronutrient dilution) revealed significantly less of most micronutrients per 4.18 MJ for men and women who consumed the most added sugar, compared with those who consumed the least.http://www.sajcn.co.za/index.php/SAJC

Influence of micronization (infrared treatment) on the protein and functional quality of a ready-to-eat sorghum-cowpea African porridge for young child-feeding

Indigenous plant foods play a major nutritional and cultural role in the diets of rural people in Africa. However, they can contain high levels of antinutrients, which may exacerbate nutritional and health problems in young children consuming nutrient deficient diets. Also, the rapid increase in urbanization in Africa has led to the need for convenience type meals. This study investigated the potential of micronization (infrared treatment) in combination with extrusion cooking in developing a ready-to-eat sorghum and cowpea based porridge supplemented with cooked cowpea leaves for young child-feeding. Micronization not only inactivated the trypsin inhibitors in cowpea, it also produced an instantized product with excellent hydration properties. When served as a stiff porridge with cooked cowpea leaves in the recommended portion sizes for children aged 2e5 years, one daily serving would meet 40% of the children's protein and lysine requirements. Further, the calculated Protein Digestibility Corrected Amino Acid Score would be comparable to commercial maize-soy instant products. This is notwithstanding that the cowpea leaves had a negative effect on protein digestibility due to their high tannin content. This nutritious ready-to-eat meal from locally available plant foods could contribute substantially to food security in both urban and rural communities in Africa.University of Pretoria Institutional Research Theme fundinghttp://www.elsevier.com/locate/lwt2016-10-31hb201

Reliability and validity of a modified MEDFICTS dietary fat screener in South African schoolchildren are determined by use and outcome measures

BACKGROUND In South Africa, noncommunicable diseases and obesity are increasing and also affect children. No validated assessment tools for fat intake are available. Objective To determine testeretest reliability and relative validity of a pictorial modified meats, eggs, dairy, fried foods, fats in baked goods, convenience foods, table fats, and snacks (MEDFICTS) dietary fat screener. DESIGN We determined testeretest reliability and diagnostic accuracy with the modified MEDFICTS as the index test and a 3-day weighed food record and parental completion of the screener as primary and secondary reference methods, respectively. Participants/setting Grade-six learners (aged 12 years, 4 months) in an urban, middleclass school (n¼93) and their parents (n¼72). OUTCOME MEASURES Portion size, frequency of intake, final score, and classification of fat intake of the modified MEDFICTS, and percent energy from fat, saturated fatty acids, and cholesterol of the food record. Statistical analyses For categorical data agreement was based on kappa statistics, McNemar’s test for symmetry, and diagnostic performance parameters. Continuous data were analyzed with correlations, mean differences, the Bland-Altman method, and receiver operating characteristics. RESULTS The classification of fat intake by the modified MEDFICTSwas testeretest reliable. Final scores of the group did not differ between administrations (P¼0.86). The correlation of final scores between administrations was significant for girls only (r¼0.58; P¼0.01). Reliability of portion size and frequency of intake scores depended on the food category. For girls the screener final scorewas significantly (P<0.5) correlated to total, saturated fat, and cholesterol intakes (butnot topercentenergy fromfat andsaturatedfattyacids intakes).The sensitivity of the modified MEDFICTS was very high (>90%), but chance corrected agreement between the classifications was poor. Parents did not agree with their children. CONCLUSIONS Testeretest reliability and relative validity of a modified MEDFICTS dietary fat screener in South African schoolchildren depended on the use and outcome measures applied.http://ac.els-cdn.comhb201

Effects of processing and addition of a cowpea leaf relish on the iron and zinc nutritive value of a ready-to-eat sorghum-cowpea porridge aimed at young children

While dietary diversification of monotonous cereal-based diets using legumes and vegetables can alleviate the high prevalence of iron and zinc deficiencies in sub-Saharan African children, laborious cooking times limit the use of particularly legumes. This study investigated the effects of high-temperature short-time (HTST) processing on sorghum (extrusion) and cowpea (micronisation), compositing sorghum-cowpea (70:30) (ESMC) in a ready-to-eat porridge and addition of cowpea leaves on iron and zinc bioaccessibilities compared to a commercial fortified maize:soy ready-to-eat porridge. HTST processing increased iron bioaccessibility from both grains and the zinc bioaccessibility from the sorghum. One serving of ESMC porridge with cowpea leaves could contribute z85 and 18% towards the iron and zinc RDA of preschool children, compared to the commercial product at z84 and 125%, respectively. However, the higher iron and zinc bioaccessibilities from the ESMC porridge with cowpea leaves, compared to the commercial product (11.8 vs. 5.0% and 18.9 vs 2.7%, respectively) means it would provide more bioaccessible iron (2.24 vs. 0.86 mg/100 g, db) and similar levels of zinc (0.35 vs. 0.32 mg/ 100 g) towards the absolute/basal requirements of preschool children. The ESMC porridge with cowpea leaves could improve the iron and zinc nutritive value of preschool sub-Saharan African children’s diets.This publication was made possible through support provided by the Office of Agricultural Research and Policy, Bureau for Food Security, U.S. Agency for International Development, under the terms of Cooperative Agreement No. AID-OAA-L-14-00003. The opinions expressed herein are those of the author(s) and do not necessarily reflect the views of the U.S. Agency for International Development. The authors would also like to acknowledge financial support for N Vilakati from the South African National Research Foundation and the University of Pretoria’s Institute for Food, Nutrition and Well-being.http://www.elsevier.com/locate/lwt2017-11-30hb2016Food ScienceHuman Nutritio

A nutrition education programme improves quality of life but not anthropometric status of adults living with HIV in Abeokuta, Nigeria

OBJECTIVE : The focus of interventions for adults living with HIV (ALH) in Nigeria has been mostly on prevention and provision of antiretroviral therapy (ART) with little consideration to nutrition-related matters. Therefore, the present study aimed to improve the quality of life (QoL) and anthropometric status of ALH in Abeokuta, Nigeria. DESIGN : A quasi-experimental design where 200 conveniently selected participants were stratified by gender and duration on ART. The intervention group (n 100) received the nutrition education programme (NEP) for 12 weeks. The control group received a brochure on nutrition guidelines for ALH. Socio-biographical information, QoL and anthropometric status were assessed using previously validated questionnaires and standard techniques at baseline, week 12 and week 24. Generalised least squares (GLS) regression analysis was used for group comparisons. Anthropometric status was summarised by gender. SETTING : Two tertiary hospitals in Abeokuta, Nigeria. PARTICIPANTS : ALH. RESULTS : TheNEP led to significant improvement in the physical functioning (week 12 and 24: P < 0·01), role limitation due to physical health (week 12: P = 0·01; week 24: P = 0·002) and pain (week 12: P = 0·01) constructs of the QoL of the intervention group compared with the control group. There was no significant difference (P = 0·07) between the mean weights of the two groups at baseline. CONCLUSIONS : There was a significant improvement at week 12 and week 24 in the QoL of the intervention participants. The results indicated that a tailored NEP could make a positive contribution to the management of ALH.The Department of Research and Innovation (DRI) of the University of Pretoria, Tertiary Education Trust Funds (TET Funds) and Red Cross International Lagos branch. The University of Johannesburg and National Research Foundation of South Africa is acknowledged for the postdoctoral fellowship support for first author (T.B.K.).https://www.cambridge.org/core/journals/public-health-nutrition2020-05-14am2019Human Nutritio